Amiodarone treatment was not associated with a significant survival benefit in patients with either HFrEF or HFpEF after adjusting for gender and age.
Cohort (n=1,872)
Yes
Does amiodarone treatment improve survival in patients with HFpEF and HFrEF?
In a nationwide registry analysis, amiodarone therapy was not associated with a survival benefit in patients with either HFpEF or HFrEF.
Abstract Introduction Heart failure (HF) affects approximately 64 million people worldwide and is frequently complicated by atrial and ventricular arrhythmias and the latter can lead to sudden cardiac death (SCD). Despite potential serious adverse effects, amiodarone is generally considered safe in HF patients. However, its efficacy across different HF phenotypes remains poorly characterized. Purpose To investigate whether amiodarone treatment is associated with prognosis in HF patients according to different phenotypes (HFpEF and HFrEF). Methods We analyzed data from the Icelandic Heart Failure Registry, which contains clinical information and test results for all HF patients admitted to a Department of Cardiology, from January 1, 2020, to December 31, 2024. Patients were stratified by HF phenotype based on left ventricular ejection fraction and amiodarone treatment status. Survival analyses were performed using Kaplan-Meier methods, log-rank tests, and multivariate Cox regression models to adjust for potential confounders. Results The final study population (n=1,872) included 824 patients with HFpEF and 1,048 patients with HFrEF, after excluding 258 HFmrEF patients, 10 without data on amiodarone use, and 61 with undetermined ejection fraction. Amiodarone treatment rates were 11.5% in HFpEF and 16.5% in HFrEF patients. Most patients (76%) presented with severe symptoms (NYHA class III-IV). In the HFpEF group the most common etiology for HF were AF (20%), hypertension (17%) and ischemic heart disease (IHD) (16%). The amiodarone treatment group was younger (76 vs 80 years), with fewer patients of NYHA class IV (23% vs 36%) and with similar gender distribution. In the HFrEF group the most common etiology for HF among was IHD (42%) followed by AF (15%) and dilated cardiomyopathy (10%). Amiodarone users were mainly men, were younger (72 vs. 75 years) and had fewer patients with NYHA class IV (30% vs. 35%). Amiodarone treated patients were more likely to have atrial fibrillation and receive anticoagulation in both study groups. Amiodarone therapy did not significantly impact survival in either HFpEF or HFrEF groups (image) and the results remained non-significant after adjusting for gender and age. Conclusion In this nationwide registry analysis, amiodarone treatment was not associated with survival benefit in either HFrEF or HFpEF patients, despite differences in baseline clinical characteristics. If a true mortality difference exists, the effect size is likely so small that a substantially larger sample would be required to detect it. These findings highlight the need for more personalized approaches to antiarrhythmic therapy in HF and warrant further investigation into alternative strategies for specific HF phenotypes.
Gudjonsson et al. (Sat,) conducted a cohort in Heart failure (HFpEF and HFrEF) (n=1,872). Amiodarone vs. No amiodarone was evaluated on Survival. Amiodarone treatment was not associated with a significant survival benefit in patients with either HFrEF or HFpEF after adjusting for gender and age.